Background/Purpose:  Chinese-Americans are one of the fastest growing immigrant groups in the US. They often use Traditional Chinese Medicine (TCM), but whether that affects medication adherence is unknown. This question is important because data suggest that ethnic Chinese have more severe SLE and RA than Caucasians, and thus nonadherence could be especially problematic. This study evaluates whether TCM use is associated with nonadherence to western medicines prescribed for chronic rheumatic diseases among Chinese-American patients. Secondary aims are to explore differences in self-reported health status between TCM users and non-users.

Methods:  Recruitment was from a rheumatology clinic that serves a predominantly Chinese-American immigrant population. A bilingual Mandarin/English speaker evaluated TCM use, medication adherence, patient-reported outcomes from the Patient-Reported Outcomes Measurement Information System (PROMIS), and other patient-level factors, all administered with validated instruments available in English and Mandarin. Inclusion criteria included speaking Mandarin or English, prescription of ≥ 1 medication by the rheumatologist, and being actively followed for a systemic rheumatic disease or OA of hands, knees, or hips. Those with only fibromyalgia, neck/back pain, or other soft tissue diseases were excluded. Adherence was analyzed as low, medium or high based on the 8-item Morisky Medication Adherence Scale.

Results:  Seventy-three enrolled, mean age 56y (range 22-97), 59% female, 77% Medicaid, and only 21% spoke English. Diagnoses included RA (37%), spondyloarthropathies (22%), SLE (15%), SS (7%), gout/pseudogout (7%), OA (3%), and other (9%). Forty-nine percent reported TCM use in the past year, most commonly massage (53%), acupuncture (47%), and herbs (44%). There was a trend for TCM use to be more common in SLE vs. RA (65% vs. 37%, p=0.5) and TCM users had a shorter disease duration (5.3 vs. 11.2 years, p=0.03). Overall, 70% reported nonadherence to rheumatic medication. In multivariate analysis adjusting for patient characteristics, TCM use was not associated with lower adherence (OR 0.34, 95% CI 0.09-1.26), while herb use was associated (OR 5.3, 95% CI 1.09-25.87). TCM users also had worse PROMIS scores in anxiety (mean T-score 52 vs. 46, p=0.01) and depression (mean T-score 52 vs. 46, p=0.007), and a trend for worse pain (mean T-score 58 vs. 56, p=0.2), fatigue (mean T-score 55 vs. 51, p=0.1), function (mean T-score 43 vs.47, p=0.1), and worse ability to participate in social roles and activities (mean T-score 55 vs.59, p=0.06).

Conclusion:  In this group of poorly integrated Chinese-American rheumatology patients, most were non-adherent with western medicines, but only herb use was associated with non-adherence. This could reflect two divergent beliefs towards TCM. In general TCM is “complementary”, but herb may be seen as an “alternative” to western medicine. In addition, TCM users had worse scores in several important self-reported health domains. This may indicate unmet needs, particularly in mental health. These associations should be explored longitudinally, including the association of TCM use and adherence on disease activity.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-traditional-chinese-medicine-use-and-adherence-to-prescribed-western-medications-in-chinese-american-rheumatology-patients/